Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation

• Published in: Hepatobiliary & pancreatic diseases international Vol. 12; no. 5; pp. 488 - 493
• Main Authors: Chan, Calvin HY, Donnellan, Fergal, Byrne, Michael F, Coss, Alan, Haque, Mazhar, Wiesenger, Holly, Scudamore, Charles H, Steinbrecher, Urs P, Weiss, Alan A, Yoshida, Eric M
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01-10-2013
• Subjects: Adult; Anastomosis, Surgical; biliary; biliary tract surgical procedures; biliary tree; cholangiopancreatography; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholestasis - diagnosis; Cholestasis - etiology; Cholestasis - surgery; Constriction, Pathologic; Endocrinology & Metabolism; endoscopic; endoscopic retrograde cholangiopancreatography; failure; Female; Gastroenterology and Hepatology; Humans; liver; liver failure; liver transplantation; Liver Transplantation - adverse effects; Living Donors; Male; Middle Aged; procedures; Reoperation; retrograde; Retrospective Studies; surgical; Time Factors; tract; transplantation; Treatment Outcome; tree; endoscopic retrograde cholangiopancreatography; biliary tree; liver failure; liver transplantation; biliary tract surgical procedures
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(13)60077-6

BACKGROUND:Endoscopic therapy has been successful in the management of biliary complications after both deceased donor liver transplantation(DDLT) and living donor liver transplantation(LDLT).LDLT is thought to be associated with higher rates of biliary complications,but there are few studies comparing the success of endoscopic management of anastomotic strictures between the two groups.This study aims to compare our experience in the endoscopic management of anastomotic strictures in DDLT versus LDLT.METHODS:This is a retrospective database review of all liver transplant patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) after liver transplantation.The frequency of anastomotic stricture and the time to develop and to resolve anastomotic stricture were compared between DDLT and LDLT.The response of anastomotic stricture to endoscopic therapy was also analyzed.RESULTS:A total of 362 patients underwent liver transplantation between 2003 and 2011,with 125 requiring ERCP to manage biliary complications.Thirty-three(9.9%) cases of DDLT and 8(27.6%) of LDLT(P=0.01) were found to have anastomotic stricture.When comparing DDLT and LDLT,there was no difference in the mean time to the development of anastomotic strictures(98±17 vs 172±65 days,P=0.11),likelihood of response to ERCP [22(66.7%) vs 6(75.0%),P=0.69],mean time to the resolution of anastomotic strictures(268±77 vs 125±37 days,P=0.34),and the number of ERCPs required to achieve resolution(3.9±0.4 vs 4.7±0.9,P=0.38).CONCLUSIONS:Endoscopic therapy is effective in the majority of biliary complications relating to liver transplantation.Anastomotic strictures occur more frequently in LDLT compared with DDLT,with equivalent endoscopic treatment response and outcomes for both groups.